Payment Integrity Business Partner II

This is a fully remote position, open to applicants in Florida, +4 more states.

📋 Description

• Act as the main point of contact for assigned health plans, markets, and stakeholders concerning Payment Integrity programs, initiatives, and issue resolution.

• Develop and sustain professional relationships with market leadership, providers, vendors, and internal business partners.

• Represent Payment Integrity in meetings, workgroups, governance forums, and strategic initiatives.

• Convey program performance, savings opportunities, operational impacts, trends, and policy updates.

• Assist in the implementation of Payment Integrity initiatives across operational, clinical, coding, analytics, compliance, regulatory, and vendor teams.

• Oversee assigned vendor relationships and evaluate performance.

• Contribute to revenue-enhancement and operational improvement initiatives.

• Assist in resolving issues involving stakeholders, providers, regulators, vendors, and operations.

• Analyze performance metrics to identify opportunities for enhancing payment accuracy, operational efficiency, and stakeholder experience.

• Document decisions, themes, risks, and follow-up actions.

• Perform additional duties as assigned.

• Adhere to all policies and standards.

⛳️ Requirements

• Must be authorized to work in the U.S. without requiring employment-based visa sponsorship now or in the future.

• Bachelor's degree and 2–4 years of relevant experience, or equivalent experience gained through applicable knowledge, duties, scope, and skill.

• Over 3 years of experience in healthcare operations, managed care, claims, payment integrity, provider relations, vendor management, or a related field.

• Experience in collaborating with and influencing cross-functional teams and business stakeholders.

• Proven ability to present information, updates, and recommendations to leadership or business partners.

• Preferred experience in Payment Integrity, claims operations, healthcare reimbursement, Medicare, Medicaid, Marketplace, or managed care operations.

• Preferred experience in managing vendors, outsourced services, or external business partners.

• Preferred experience supporting provider, regulatory, compliance, audit, or revenue-enhancement activities.

• Preferred experience in interpreting operational, financial, or performance data.

• Certification as a Project Management Professional (PMP)-PMI and/or Lean Six Sigma certification, along with related project, process improvement, or operational excellence experience, is strongly preferred.

🏝️ Benefits

• Competitive pay.

• Health insurance.

• 401K plan.

• Stock purchase plans.

• Tuition reimbursement.

• Paid time off plus holidays.

• Flexible working options including remote, hybrid, field, or office work schedules.

• Additional forms of incentives may be included in the total compensation.